Treatment of pruritus by capsaicin in a patient with pityriasis rubra pilaris receiving RE-PUVA therapy

Abstract

Pityriasis rubra pilaris (PRP) is characterized by redness of the skin, scaling and a variable degree of pruritus. We present a patient with extremely itchy PRP successfully treated with oral retinoids and photochemotherapy with 8-methoxypsoralene (RE-PUVA) and topical capsaicin. The PRP-related pruritus which clearly preceded photochemotherapy and for which no other cause was apparent was relieved with capsaicin. This single case report provides evidence that topical capsaicin may be a useful therapeutic option in treating PRP-associated pruritus where antihistamines have been unsuccessful.

Pityriasis rubra pilaris: algorithms for diagnosis and treatment

“…41 Pimecrolimus has been described to be an effective alternative to corticosteroids. 42 Other reports show a supportive, symptomatic effect of a 0.03% capsaicin solution against itching and brimonidine gel for recalcitrant facial erythema 43,44 (Table. 2).…”

“…For symptomatic relief, emollients, keratolytics and systemic antihistamine therapy can be helpful . However, as antihistamines are mostly unsuccessful, a topical capsaicin solution (0.03%) might be a useful therapeutic option in treating PRP‐associated pruritus . Taken together, topical treatment as monotherapy may be of help in less severe cases.…”

“…29 However, as antihistamines are mostly unsuccessful, a topical capsaicin solution (0.03%) might be a useful therapeutic option in treating PRP-associated pruritus. 43 Taken together, topical treatment as monotherapy may be of help in less severe cases. In PRP, in which escalation of therapy is necessary, topical treatment is used in combination with systemic therapies.…”

“…9 Another possibility is the combination of retinoids and phototherapy. Acitretin has been reported as being effective when in combination with narrowband UVB, 55,56 UVA1 57 and PUVA (so-called Re-PUVA), 43,58 whereas Gemmeke et al 59 described that the treatment response with Re-PUVA was much slower in the two PRP patients than in patients with psoriasis. Due to the described photoexacerbation of PRP, photo testing is advisable prior to the treatment.…”

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“…It is found that, 24 h of treatment with capsaicin caused a 15% decrease in perfusion in lesional skin and pityriasis rubra pilaris (PRP) which is characterized by redness of the skin, scaling and a variable degree of pruritus 110 . It is found that a patient with extremely itchy PRP treated with capsaicin was apparent relieved 111 . Capsaicin is also used in the treatment of prurigo nodularis, which is an eruption of lichenified or excoriated nodules caused by intractable pruritus and pruritus ani (intense itching localised in the anus and perianal Skin) 112 .…”